Migratory flows that exceed the numbers seen in the western Mediterranean, with more than eighty nationalities living side by side in the Central American corridor, mobile and local populations that are both subject to multiple forms of violence. The author produces a horrific assessment of a much underestimated crisis which, surprisingly, could bring about much needed change in humanitarian practices in this part of the world.
When an operational culture is profoundly inscribed in an organisation such as Doctors Without Borders (Médecins Sans Frontières – MSF) and crafted through decades of provi ding emergency responses and health services, every now and then, the fast-paced shifting global context pushes for new sorts of responses. In particular, traditional humanitarian contexts are now more “complex”, requiring new sets of operational models. Fresh strategies are required to launch operations in response to structural cracks where existing institutions fail to cover critical vulnerabilities, from disease outbreaks to large-scale population movements.
The Central America region is generally misunderstood when analysed through traditional humanitarian intervention prisms. Its challenges are often disregarded as false humanitarian contexts, especially by host governments and humanitarian donors, despite having murder rates and population displacement greater than most conflict zones. Consequently, humanitarian budgets are deprioritised, and critical aid resources do not reach those who need help.
Moreover, some governments have been reluctant to acknowledge the humanitarian concerns expressed by independent reports and therefore to allow coordinated responses to humanitarian needs. In this context, humanitarian organisations have had to question their traditional approaches to operations to ensure activities stay relevant and to improve quality-based impacts.
The objective of this article is to share an analysis of the political- humanitarian landscape in Central America and Mexico’s regional context of human mobility; present the key operational challenges of addressing the humanitarian needs of people on the move in this region; and finally, explore MSF’s programmatic approach to these particular needs.
An invisible transnational humanitarian crisis
After the mid-1990s, armed uprisings in Central America and Mexico ceased, yet human-made humanitarian crises persisted. From the record number of mis sing people in Mexico related to the war on drugs to the mara-ridden gang wars and systemic violence affecting urban and rural communities, the region still faces myriad forms of violence, including gender-based violence. One transverse consequence of the various forms of violence has been human mobility. It reflects violence experienced both in places of origin and in places where safety is sought.
Migration by choice or by force in the region has shaped a large number of communities in the Northern Triangle of Central America (Guatemala, El Salvador and Honduras) and in Mexico, fashioning one of the world’s busiest migrant corridors. Since 2018, the regional route has expanded to include the migrant corridor from South American countries and beyond. The Darién Gap, the infamous impenetrable jungle between Colombia and Panama, has become a bottleneck of more than eighty nationalities ranging from Haitian to Chinese.
“Violence experienced during mobility has been ubiquitous and multifaceted, a constant through the years for this population.”
In this region, violence experienced during mobility has been ubiquitous and multifaceted, a constant through the years for this population. Its consequences have been reported extensively by the media, human rights organisations, academia and humanitarian organisations, including MSF. To illustrate one facet of this violence, this year, in just seven months, MSF provided at least 516 consultations to victims of sexual violence cases in Panama, Honduras, Guatemala and Mexico.Médecins Sans Frontières, “‘We are tired and desperate’: Stories from families who survived the Darién Gap”, 17 June 2022, … Continue reading Incidentally, for years, even the national human rights commissions and United Nations agencies have noted that the extorsion and kidnapping of people on the move involve diverse authorities, from local police to migration authorities and have often been linked to criminal organisations.Comisión Nacional de los Derechos Humanos, Informe Especial sobre Secuestro de Migrantes en México, 22 February 2011, … Continue reading
Families, single pregnant mothers, unaccompanied children have all been victims of violence. While for years humanitarian organisations such as MSF have been advocating for safe and dignified migration routes, most countries in the region pretend that migration is not a humanitarian issue. Pressure from the United States (US) to dissuade migration has compelled administrations in the region to take extreme measures contrary to their own legal frameworks. This includes Guatemala’s violent repression of a migrant caravan in January 2021.Francesco Manetto, “Guatemala frena por la fuerza la caravana de migrantes que se dirige hacia México”, El País, 17 January 2021, … Continue reading In Mexico, it has incentivised a culture of impunity that has led to fatal consequences, such as the March 2023 incident in Ciudad Juarez, where forty migrants died as a result of a fire in a detention centre.Jessica Xantomila, “Activistas exigen justicia al INM por muertes en estación de Cd. Juárez”, La Jornada, 30 June 2023, … Continue reading
These practices have come on top of the US’s own dissuasive policies such as metering, the Migrant Protection Protocols (better known as the “Remain in Mexico” policy) and Title 42, which entrenched the pre-existing exposure to violence. With increasing barriers to mobility, Mexico’s northern cities have hosted thousands of people and seen the emergence of makeshift camps. Following federal inaction, the few responses in those cities have been limited to local authorities and some local and international organisations.
Although all regional governments, except for Belize, have taken steps to decriminalise irregular migration and endlessly stated their respect for human rights, most governments have closed their eyes to the size of the crisis and the need for safety and dignity of people on the move. Consequences have been the emergence of legal and administrative barriers, the increase of impunity on abuses led by state agents against this population and limited access to basic services, including healthcare.
Similarities can be found in other contexts, where humanitarians work outside the margins of state responses to assist structurally discriminated populations. Those who have worked in other migration settings, such as Libya, might find strong resemblances.Médecins Sans Frontières, Out of Libya: Opening Safe Pathways for Vulnerable Migrants Stuck in Libya, June 2022, … Continue reading Libya and the migration routes that lead to and out of the country are also dark and full of terrors.
A contrasting case has been Honduras. Despite being the poorest country in the region, it is the only one that has accepted the challenge of respon ding to the humanitarian needs of people on the move crossing its territory. Even with limited resources, Honduran authorities have pushed for resource mobilisation prompting domestic and foreign actors to engage in multi-level sectorial coordination. In the following section, we will dissect and analyse the programme adaptations to this complex humanitarian context.
Programming a humanitarian response along a route of over 6,000 km
Humanitarian programming for people on the move in Central America and Mexico is a complex endeavour. The sheer number of people in need is overwhelming. Their needs change constantly, policies shift frantically and discordantly among the different countries in the region, and security management is a recurrent challenge.
“In only seven months, from January to July 2023, 250,000 people crossed from Colombia to Panama, matching the total number for 2022 and doubling those for 2021.”
As mentioned previously, since 2018 the number of people on the move has increased significantly. Encounters at borders give a glimpse of the estimated number of people that take the routes through the Central American and Mexican territories. In only seven months, from January to July 2023, 250,000 people crossed from Colombia to Panama, matching the total number for 2022 and doubling those for 2021.Ministerio de Seguridad Pública, Situación del flujo migratorio, Gobierno de Panamá, 22 August 2023 https://www.migracion.gob.pa/inicio/estadisticas Honduras saw a 900% increase between 2021 and 2022.Nadia Mendoza, “Cifra de migrantes extranjeros en tránsito por Honduras se dispara más del 900% en el 2022”, Blog DIRCOM UNAH, Universidad Nacional Autónoma de Honduras, 17 April 2023, … Continue reading And in Mexico, migratory authorities arrested 444,439 people in 2022, including 70,000 based on their irregular migratory status, thus representing an overall 44% increase compared to the previous year.Unidad de Política Migratoria, Registro e Identidad de Personas, México, Estadísticas Migratorias, Síntesis 2022, September 2023, … Continue reading Comparatively, in the Mediterranean, the United Nations High Commissioner for Refugees registered in 2022 up to 159,000 sea and land arrivals to southern European countries.United Nations High Commissioner for Refugees, Mediterranean Situation – Demography of Mediterranean sea arrivals from January 2022, https://data2.unhcr.org/en/situations/mediterranean
Needs assessments of people on the move constantly point to different priorities. The social composition of the population evolves incessantly, with a large variety of overlapping vulne rabilities, ranging from gender to age, nationality and sexual orientation. For instance, Haitians, Afghans and some African nationalities have faced cultural and linguistic barriers to mobility, on top of the stigma and discrimination. However, the most common denominator is violence, whether it is in the place of origin or transit, or associated with factors such as gender, organised crime or state persecution. Some even prepare for it: it has become more common for Central American women and girls to request pre-exposure prophylaxis to prevent the consequences of potential sexual violence along the route.Médecins Sans Frontières, PrEP – Mexico and Central America 2022-2023 internal medical DHIS database, 2023. State crackdowns and the absence of a coordinated humanitarian response have also accentuated vulnerabilities.
“It has become more common for Central American women and girls to request pre-exposure prophylaxis to prevent the consequences of potential sexual violence along the route.”
The geographic space adds a layer of complexity. Some 6,300 km separate the community of Yaviza, deep in the forest of Panama, from Tijuana, the northwesternmost point along the migration route and an important crossing into the US. Each section of the way has its own contextual characteristics, including migration patterns and specific humanitarian needs. The contexts range from informal camps right outside the Darién jungle in Panama to the border crossings in Central America where the migratory flow goes both ways, south to north and north to south for those being deported. At some points like the southern Mexican city of Tapachula and the Mexican capital, Mexico City, people on the move stay in place for months, sometimes living on the street, seeking documents that will give them rights.
Furthermore, the overwhelming presence of criminal groups, spread along the route, clashing with other criminal groups and state security forces, has led to a frenetic spiral of violence, the disruption of the security apparatus and, most importantly, to an unpredictable security environment for humanitarian actors. The International Committee of the Red Cross has labelled these contexts as “other situations of violence”.International Committee of the Red Cross, “The ICRC’s role in situations of violence below the threshold of armed conflict”, Policy document, International Review of the Red Cross (2014), Vol. … Continue reading From the anarchic Darién jungle to the Petén jungle in Guatemala, passing through the trafficking borderlands, criminal groups see people on the move as a valuable transnational currency. Humanitarian organisations’ security is closely related to the criminal groups’ perceptions of competition and interference in their business. Providing services that can disrupt their logistics or their income model can have serious consequences. The initiative taken by Mexican shelters and US lawyers in Nuevo Laredo to improve crossings under the Title-42 exemption model prompted in October 2022 direct threats to humanitarian actors and migrants and ultimately to the closure and withdrawal of all activities from the city, MSF included.Julia Neusner and Kennji Kizuka, “Fatally flawed: ‘Remain in Mexico’ policy should never be revived”, Informative briefing, Human Rights First, 22 September 2022.
By upholding humanitarian principles, humanitarian organisations have challenged the national denial of this protection crisis, responding to needs and engaging with beneficiaries. Yet it is noteworthy that even big international organisations have seen little leverage in their bilateral conversations with the governments and have been pushed to level with and join local community leaders and fellow civil society orga nisations when raising awareness about the current crisis.
Structural adaptation to humanitarian responses
MSF has been addressing the needs of people on the move in Mexico since 2012 with a mobile model covering numerous key transit points in Mexico. At that time, most of its other projects in the region were looking at impro ving access to health for victims of violence. From 2018 onwards, the profiles and needs of people on the move pushed for a sturdier regional operational response.
In 2018, a project that initially focused on responding to the consequences of “local violence” shifted to addressing the specific needs of people on the move temporarily located in the cities of Reynosa and Matamoros in northern Mexico. Shortly after, a project was also opened in the Darién province of Panama to assist the vast number of victims of sexual violence. In addition, a project was started in Honduras with mobile clinics to cover the health needs of dynamic populations, from the caravans that followed the Eta and Iota hurricanes to the mass arrivals of people at the southern border. In Guatemala, another project was opened to provide continuity of care, assistance to deportees and safe spaces. Finally, a catalytic project was opened in Mexico City, where surprisingly MSF identified that, despite being the largest urban centre in the region, with an open migration policy, people on the move faced more barriers to health compared to Reynosa and Tapachula: 18% of those who sought healthcare had the service literally denied.Médecins Sans Frontières, Migration History Tool 2022: Preliminary results, December 2022.
The concept was therefore to create a series of linked projects, each with its own characteristics and specialisation. It would allow adapted responses to each context, while providing the core services of primary healthcare, comprehensive care for victims of sexual violence, mental health, and social work. MSF has also included “protection” as a stand-alone component within the opera tional ana lysis, serving as an operational prism to analyse the needs, adapt the operatio nal response and evaluate the pertinence of MSF’s intervention within the ge neral context. Moreover, this prism has facilitated the organisation’s interest in better integrating its assistance programming within protection networks and enhancing its advocacy.
In terms of security, despite the threats armed actors have made to other humanitarian actors, MSF has managed to avoid serious incidents and never had to engage directly with these non-state armed groups. This has been achieved by ensuring constant visibility and clarity of its operational objectives among all stakeholders. Indirectly, this has ensured that all actors can easily identify and distinguish MSF.
Other notable innovative operational ada ptations have also included cultural mediation to address diversity and communication with people on the move from a growing number of diffe rent nationalities. Moreover, primary and mental healthcare strategies have been tailored to the limited contact time with patients. Finally, it is worth underlining that the organisation has recognised the importance of a more holistic humanitarian approach when addressing the humanitarian needs of people on the move. This includes the provision of Wi-Fi hotspots, the dissemination of violence prevention messages and the promotion of the assistance network, in partnership with other actors.
When designing these programmes, the non-traditional humanitarian contexts of Mexico and Central America have encou raged self-critique and defied standard operational approaches. MSF has found in these contexts the opportunity to address a single humanitarian problem in a multiplicity of approaches, developing differentiated models of care and promoting catalytic projects.
“Other humanitarian settings, in other corners of the world, seem to be evolving similarly: mostly urban-centred, highly insecure .”
What is particularly noteworthy is that other humanitarian settings, in other corners of the world, seem to be evolving similarly: mostly urban-centred, highly insecure and where states dismiss the needs of highly discriminated against populations affected by pervasive violence. In that sense, Central America and Mexico seem to have the potential to become fertile ground for case studies and a laboratory for exploring new approaches to humanitarian action.
The author would like to thank the support from his colleagues for their support and comments. This article reflects the views of the author and not those of the organisation to which he belongs.